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Suffered Head Trauma Earlier. Ear/head Pressure, Tight Neck, Built Up Mucous In Mornings, Popping Jaws. What Is It ?

Posted on Fri, 5 Oct 2012

Question: I suffered a head trauma two years back (wore a cap in an experiment study that was put on too tight for several hours), which gave me a concussion, and I experienced head pain (mostly in the back of the head and top) on one side for several months after that.

This seemed to briefly go away, and then I started experiencing extreme pressure on the same side of the head (back of the head). Ongoing pressure throughout out the day. Best in mornings and evenings; worse in afternoons.

Symptoms get much worse with movement. Running is out of the question. At times, even walking to work is painful. Movement causes increased pressure (one side), dizziness.

Went from neurologist to ENT. ENT gave me Mucinex, allergy medications, nasal sprays. Mucinex definitely helped. Seemed like a mucous clearing issue. Sinus CT scan showed unilateral abnormality on same side as symptoms; a concha bullosa. Went in for surgery; removed concha; fixed minor deviated septum; inferior turbonate reduction.

Better mucus drainage afterwards. Previous story was over a 2 year time frame. However, still having these symptoms:

-Ear/head pressure on one side; back and side of the head; by the ear; seems inside the ear too; pain increases with movement
-Tight neck; swollen muscle near mastoid (SCM?)
-Eustachian tube (or maybe jaw) pops when stretching neck muscles, and breathing in XXXXXXX through nose
-Built up mucous in mornings on affected side; slowly work to clear out mucous throughout the day

What's the cause of these last symptoms? These (and all other symptoms) have always been unilateral. Why does my neck feel tight/swollen when ear pressure/ET symptoms increase? Why does stiff neck correlate with a feeling of built up mucous?

Negative scans:
MRI, CT

Helpful treatments:
Antibiotics (biggest help; seemed to thin out mucous; but long-term use seems extremely risky)
Mucinex
ENT surgery; seemed to open up passages; easier to clear out mucous
Aerobic excercise (on a bike; not running; as excessive movement induces pain)

Answered by Dr. Naveen Kumar Nanjasetty (4 hours later)

Hi

Thanks for the query and an elaborate history

You have complex problems related to a small area. Most of the symptoms related to the ear and the head could be due to the chronic sinusitis and the mucus usually happen in those individuals with sinus related problems. During night there is gradual accumulation of the nasal and sinus secretions due to the posture, once you wake up in the morning the accumulated secretions start clearing of because of the gravity and almost clears of by afternoon or evening. This is a typical feature of sinusitis.

The second problem is due to Eustachian tube dysfunction (ETD). In ETD, there is pressure variation between the middle ear and backside of the nose due to inefficient function of the Eustachian tube, leading to pressure build up in the ear. The popping of the ears following yawning, swallowing, neck movements can be attributed to this problem. The increase in pain in the ear on neck movements is due to the presence of the few muscles of the pharynx in close relation to the Eustachian tube opening. Thus, when there is neck movement the pharyngeal muscles it will irritate an already inflamed Eustachian tube giving rise to pain in the ear.

1. Why does my neck feel tight/swollen when ear pressure/ET symptoms increase?
A: This happens in those conditions wherein there is stress, acid reflux from the stomach into the throat and neuro-muscular disorder. Stress and neuro-muscular disorder can cause spasm and swelling of the neck muscles giving rise to pain on that part of the neck. This in turn, irritates the muscles around the Eustachian tube opening giving rise to earache as well as pressure build up in the ear. Secondly, reflux of the acid contents from the stomach into the throat can cause inflammation in the throat which in turn can transfer the pain to the ear due to the common innervations.

2. Why does stiff neck correlate with a feeling of built up mucous?
A: As I mentioned before stiff neck could be due to stress and during stress the acid reflux increases. Mucus build up in the throat could be due to acid reflux from the stomach causing inflammation of the mucosa of the throat and excessive salivary secretions are produced to reduce the inflammation.

Mucinex will help in reducing the consistence of the secretions, but that is not enough, you need to do steam inhalation (this helps in reducing the nasal congestion and thus opening of the sinus), consume plenty of warm water (to clear the throat congestion and for hydration of the tissues) and use saline nasal spray 3-4times/day (helps in keeping the nose moist and also easy movements of nasal secretions). Also, you need to consult with your doctor regarding acid reflux and the medications for the same. Regarding swelling of the sternocleidomastoid muscle, it would be better to consult a good neurologist.

Hope this answers your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naveen Kumar Nanjasetty (16 hours later)

Dr. XXXXXXX

Thanks for your detailed and informative response. As a followup, I do have a few - I think - more difficult and precise questions.

[1] All symptoms are unilateral. Doesn't this rule out symmetrical causes like stress and acid reflux?

[2] Out of the three main symptoms: stiff/swollen neck (muscles?) by mastoid, ETD, and viscous mucous, what's the causal chain? Is sinusitus causing ETD and the stiff neck. Is ETD causing the other two. Is the stiff neck causing the other two, etc. Is there an underlying cause that's making all 3 symptoms appear? This is what I'd really like you to take a shot at. An underlying cause for all 3 unilateral symptoms.

[3] Oh, and just to throw in another detail. Why do antibiotics unquestionably help? seems that mucous is thinned while taking antibiotics. Is there a way for antibiotics to help and 'not' have a bacterial infection? This one has my local ENT stumped BTW.

Thanks,
-XXXXXXX

Answered by Dr. Naveen Kumar Nanjasetty (11 hours later)

Hi

Welcome back

1. All symptoms are unilateral. Doesn't this rule out symmetrical causes like stress and acid reflux?
A: Yes, occasionally acid reflux does cause unilateral symptoms, the cause of which is not known. A neuromuscular problem can be unilateral which could worsen during stress. Not all stress related problems can cause neck pain or stiff neck, but can definitely cause acid reflux disorders.

2. Is there an underlying cause that's making all 3 symptoms appear? This is what I'd really like you to take a shot at. An underlying cause for all 3 unilateral symptoms.
A: It is not possible that, all the three problems could be inter-related. Both sinusitis and acid reflux could cause accumulation of the phlegm in the throat. The physiology of this condition is already explained in my previous post. But, when you are having both, then the throat symptoms will be much worse than what it would be when either of them is present. Regarding, swelling of the sternomastoid, the undue stress in a neuro-muscular disorder following head injury could be the triggering factor. Only an apt neurologist can confirm this.

3. Why do antibiotics unquestionably help? seems that mucous is thinned while taking antibiotics. Is there a way for antibiotics to help and 'not' have a bacterial infection?
A: Yes, it is possible; most of the antibiotics posses mild anti-inflammatory activity also, which helps in reducing the inflammation and excessive secretions.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar